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Consultations offered at our five convenient locations in Calhoun, GA, Chattanooga, TN, Ooltewah, TN, Franklin, TN and Blueridge, GA

Patient Information Form

    YesNo
    DiabetesBlood ClotsCancerHeart DiseaseOrgan TransplantsOtherNone
    Choose For MeDr. Deal - (DRHIDEF)Dr. Kluska - (DRDADDYK)Dr. GardnerDr. Summers

    Please use the "choose file" buttons below to upload photos to send to us.

    • Use a solid background.
    • Take photos of the affected area from different angles.
    • Images MUST be smaller than 6mb each
    • Filetypes accepted are jpg, jpeg, png, and gif.

    Very large images may take up 5 minutes to upload. Please be patient and wait till loading has finished before navigating away from this page.

    Breast EnhancementFace & NeckBody & AbdomenBelow-The-WaistInjectablesMedSpa
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                Consultation Page Form

                  Please use the "choose file" buttons below to upload photos to send to us. We can not process a virtual consultation without images.

                  • Use a solid background
                  • Take photos of the area of interest from different angles
                  • Images MUST be smaller than 6mb each
                  • Filetypes accepted are jpg, jpeg, png, and gif
                  • Large images may take a while to upload

                  All information sent will remain private. Please allow 24 hours for us to get back to you.

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                  Contact Page Info

                    Choose For MeDr. Deal - (DRHIDEF)Dr. Kluska - (DRDADDYK)Dr. GardnerDr. Ray - (MCDREAMYHIDEF)Dr. Mason - (DRROCKINHIDEF)Carey Miller, MSN, NP-C (LIFE Wellness)Dr. Summers
                    YesNo
                    DiabetesBlood ClotsCancerHeart DiseaseOrgan TransplantsOtherNone
                    YesNo

                    Please use the "choose file" buttons below to upload photos to send to us.

                    • Use a solid background.
                    • Take photos of the affected area from different angles.
                    • Images MUST be smaller than 6mb each
                    • Filetypes accepted are jpg, jpeg, png, and gif.

                    Very large images may take up 5 minutes to upload. Please be patient and wait till loading has finished before navigating away from this page.

                    Breast EnhancementFace & NeckRhinoplastyBody & AbdomenBelow-The-WaistInjectablesMedSpa
                    YesNo
                    BillboardInstagramFacebookSnapchatWeb SearchOther
                    Protected by Recaptcha. Privacy & Terms